Health Home December 1, 2016 Billing Changes Implementation Survey |
The purpose of this survey is to collect from providers feedback on options for implementing Dec. 1, 2016 Health Home billing changes. Please read the following information and then respond to the questions below by Oct. 7, 2016.
Prior to submitting a HH PMPM claim to Medicaid for dates of service on or after 4/1/16, HML information MUST BE SUBMITTED to MAPP HHTS. Direct billing by converted CMAs will end as of December 1, 2016 dates of service. In alignment with these changes, effective December 2016, MCP capitation rates (Mainstream, HARP and HIV/SNP) will include estimated HH PMPM for Dec. 2016 - March 2017 service dates, plus up to one additional month of payments. This means that MCPs will no longer submit HH PMPM claims to Medicaid for payment - reducing the time it takes to process and pay HHPMPM claims to the Health Home and then to the Care Management Agency. MCPs will pay HHs as soon as they receive confirmation through the MAPP HHTS Billing Support that a billable service was provided using pre-payments included in the Dec 2016 capitation payment.
DOH has identified two possible options for providers to use the MAPP HHTS to exchange billing information about MCP members for service dates on or after Dec. 1, 2016:
Prior to submitting a HH PMPM claim to Medicaid for dates of service on or after 4/1/16, HML information MUST BE SUBMITTED to MAPP HHTS. Direct billing by converted CMAs will end as of December 1, 2016 dates of service. In alignment with these changes, effective December 2016, MCP capitation rates (Mainstream, HARP and HIV/SNP) will include estimated HH PMPM for Dec. 2016 - March 2017 service dates, plus up to one additional month of payments. This means that MCPs will no longer submit HH PMPM claims to Medicaid for payment - reducing the time it takes to process and pay HHPMPM claims to the Health Home and then to the Care Management Agency. MCPs will pay HHs as soon as they receive confirmation through the MAPP HHTS Billing Support that a billable service was provided using pre-payments included in the Dec 2016 capitation payment.
DOH has identified two possible options for providers to use the MAPP HHTS to exchange billing information about MCP members for service dates on or after Dec. 1, 2016:
- CMAs/HHs work together to submit HML Assessment information into MAPP HHTS. MCPs pull down the Billing Support Download (BSD) file, convert that file into a format that their billing system accepts and submit that file into their billing system to trigger payment to the Billing Entity identified on the BSD file.
- CMAs/HHs work together to submit HML Assessment information into MAPP HHTS. HH then submits claim information directly into the MCP billing system. MCP must then compare billing information submitted into their billing system to information on the BSD file and ONLY pay the submitted claim if the rate code and biller on the claim match the Rate Code and Billing Entity values on the BSD.